Chronic Pain in Lupus

by Karyn Moran Holton

Chronic pain. Pain that goes from bad to worse to unbearable. Pain that lives with you every day of your life, never ceasing, not even long enough to get a night's sleep, is one of the worst things about having lupus.

Because lupus primarily affects women, I found it interesting that the National Institute of Health noted that women report more severe and chronic pain than men, and urged doctors to factor sex into diagnosing, treating, and researching chronic pain management. (JAMA, 280:120-124. 1988)

The NIH Revitalization Act of 1993 mandated that women and minorities be included in clinical research. Previously, pain research had been male-oriented because of (get this) "The alleged rationale has been that the estrus cycle in women would confuse the results."

It may be true that women react to pain differently than men do. Dr. Lesche of NIH states, "Pain may arise in women with differences in anatomy or physiology of neural systems, perception of pain, and the cognitive and emotional ways of dealing with pain." If pain may arise in women, then more research is needed focusing solely on chronic pain in women! Simply ignoring women's pain is not a viable solution, and more therapies for the relief of chronic pain must be found.

The first line of defense against chronic pain in inflammatory diseases like lupus and arthritis has always been pharmacological. Non-steroidal anti-inflammatories (also called NSAIDs) such as aspirin and ibuprofen (Advil or Motrin) have been used to treat mild cases with success. For more intense pain that does not respond to NSAIDs, narcotic analgesics, such as demerol and morphine may be used. However, for some patients with chronic pain, the addictive effects of narcotics may be too much for them to be used on a long-term basis.

This is where alternative therapies have stepped in. Pain relieving techniques like hypnosis and magnetic stimulation therapy have given patients a non-medicinal alternative that may be more beneficial in the long term.

Dr. P. Logue, of Duke University Medical Center's Department of Psychiatry and Behavioral Sciences, made some statements regarding hypnosis: "It is known that a patient's cognitive and emotional state can influence their physiological system. Changes in their physiological state can affect their overall function. This intimate mind/body relationship can be used to treat painful states via hypnosis. Enhancing the nervous systems inhibitory process can modify pain...Hypnosis can induce a state of relaxation, calmness and peacefulness, even in the midst of external distress. This temporary state of calm can effectively reduce a patient's subjective experience of pain." Dr. Logue also stated, "Why would any clinician want to use a procedure that must be explained and justified to the 'outside' world? Because it works. Not always in a spectacular fashion, not with every patient, and not with every condition, but it does work." (NC Medical Journal, 53[3]:176-179, 1988.). In NIH studies, 75-80% of patients had a positive reaction to hypnosis.

Another fairly new type of therapy for chronic pain is magnetic stimulation. According to Dr. J. Pujol of the Magnetic Resonance Center of Pedralbas in Spain, a study using magnetic stimulation to localized pain reduced pain 29 (out of 101) points in patients. In a sham situation, patient's pain was only reduced 8 points. In a test using a sham stimulation, and then using magnetic stimulation, patient's perception of pain dropped 30 points after magnetic stimulation. The effects can last up to a few days, as opposed to a few hours for medicinal therapies. (NeuroReport 9[8] 1745-1748, 1998.)

Perception of pain is as individual as each person. What works for one person may not work for another. It may be helpful for the person living with chronic pain to experiment with different therapies. It is advisable to start with the least invasive, or least expensive, therapies and go on from there. Try using ice packs before taking medication, and try medication before seeing a surgeon. The main thing to remember is that no one needs to suffer needlessly, and to keep looking until you find the pain relief that works for you!

© 1999 Karyn Moran Holton

Karyn Moran Holton is a nurse who has been diagnosed with lupus for the past 3 years, and has spent most of that time trying to raise awareness about lupus and other under-appreciated autoimmune diseases.